The Luhr fixation system for the craniofacial skeleton.

The use of miniplates and screws in elective osteotomies or acute trauma of the craniofacial skeleton has revolutionized this field. In jaw surgery, rigid fixation has eliminated the need for intermaxillary fixation in most cases. Bone grafts and bone segments are more easily kept in place by screws or plates, rather than the balancing act that had to be done with wire fixation. This has decreased morbidity and the risks of postoperative airway obstruction. Thus, more complex procedures can be done and younger children treated. Most craniofacial surgeons now using plates and screws are finding less postoperative swelling after elective surgery. The reason for this is not immediately obvious, although supposition is possible. The disadvantages of the use of plates and screws are, first, that the surgery must be more precise than when wire fixation is used especially jaw surgery. Second, all the systems are more expensive than wires. However, in a well-organized insurance system, the cost is offset by decreased use of intensive care units, decreased hospital stay, greater safety and less morbidity for the patient, and probably fewer complications from slippage of bone segments or infection.